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STN Society of Trauma
Nurses
ATCN Advanced Trauma Care for Nurses
ATCN Knowledge-Based Exam &
Trauma Simulation Assessment
Course Title and Number: ATCN Advanced Trauma Assessment Exam Title: ATCN Exam Exam Date: Exam 2025- 2026 Instructor: ____ [Insert Instructor’s Name] _______ Student Name: ___ [Insert Student’s Name] _____ Student ID: ____ [Insert Student ID] _____________
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ATCN Module 4: Shock & Hemorrhage
Control ATCN Advanced Trauma Care for
Nurses Module Review Questions and
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ATCN Knowledge-Based Exam & Trauma
Simulation Assessment
ATCN Advanced Trauma Care for Nurses
Exam
Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - 1.Your patient is a 15-year-old who was thrown from his horse during a jumping competition. His skin is pale and cool. Vitals are: BP-98/68, P- 132/min, R-24/min. He has an abrasion from his left nipple laterally down to his pelvis. His abdomen and pelvis are diffusely tender. He has mild difficulty breathing, and breath sounds are diminished on the left: What is the probable cause of his shock? Is this compensated or uncompensated shock? Explain how you will initiate IV therapy to gain maximum benefit for this patient. What other paramedical care will be needed for him? Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱 Click Here To <> Follow Link
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📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here : 📱 Hybridgrades101@gmail.com V Ppf Fcf(ipepcp) F: Vasoconstriction Platelet plug formation Fibrin clot formation -Intrinsic pathway - APTT or PTT -Extrinsic pathway - PT -Common pathway Fibrinolysis
- Defining Shock:
- Inadequate tissue: perfusion
- Can result from variety of disease states and injuries Can affect entire organism or occur at: tissue or cellular level
- Not adequately defined by:: Pulse rate Blood pressure Cardiac function Hypovolemia Loss of systemic vascular resistance
- Adequate oxygenation of tissue cells (perfusion) depends on:: Heart Vasculature Lungs
- If any one malfunctions? may occur: decrease in cellular oxygenation may occur
- Cardiac Output Depends on: (3): Venous return to ventricle (preload) Strength of contraction Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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- Help control BP by two negative feedback mechanisms:: Lower BP in re- sponse to increased arterial pressure Increase BP in response to decreased arterial pressure
- Low arterial pressure stimulates: peripheral chemoreceptor cells in carotid and aortic bodies
- If oxygen or pH decreases, this stimulates the: vasomotor center of medulla
- Compensatory Mechanisms CNSir Hm Rotf Sdob: CNS ischemic response Hormonal mechanisms Reabsorption of tissue fluids Splenic discharge of blood
- Hormonal mechanisms Amm Raam Vm Anf: -Adrenal medullary mechanism -Renin-angiotensin-aldosterone mechanism -Vasopressin mechanism -Atrial natriuretic factor
- Adequate cellular oxygenation requires that adequate oxygen be available to red blood cells at the capillary membrane in the lungs Made possible by: (3): High pressure of oxygen in inspired air Adequate depth and rate of ventilation Matching of pulmonary ventilation and perfusion Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here : 📱 Hybridgrades101@gmail.com Coronary arteries decreasing supply of oxygenated blood to heart. If blood loss stops, cardiovascular system draws fluid from interstitial space. Kidneys reduce urine output to conserve water and electrolytes.
- Capillary microcirculation: Sympathetic stimulation and reduced kidneys, pan- creas, liver perfusion cause hormone release. Circulation limited to only organs most critical to life. Increase in cellular hypoxia in noncritical tissues. Compensatory mechanisms begin to fail. Capillary walls and cell membranes break down. Red blood cells clump together in hypoxic and stagnant capillaries; columns of coagulated erythrocytes (rouleaux formation).
- Capillary washout: Profound metabolic acidosis and microscopic emboli. Cardiac output, peripheral vascular resistance, blood pressure, cellular perfusion drop toward zero. Body moves quickly and irreversibly toward death.
- Compensated Shock: Signs and symptoms of early shock:: Blood pressure normal or high Treatment typically results in recover
- Uncompensated Shock Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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- Irreversible Shock Signs and symptoms of late shock: Blood pressure abnormally low Even aggressive treatment does not result in recovery
- Classification of Stages of Shock (how many?):
- Physiological Response to Shock Variations and determining factors: Age and relative health Older adults Children General physical condition Preexisting disease Ability to activate compensatory mechanisms Medications Specific organ system affected
- Management of Shock: Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here : 📱 Hybridgrades101@gmail.com Rapid trauma assessment and immediate transport for patient with serious internal hemorrhage, uncontrolled external hemorrhage, or shock. Focused trauma assessment for patient with isolated injury and no significant MOI
- Rapid trauma assessment: Serious injury and/or significant MOI. Quickly inspect and palpate patient from head to toe. If significant hemorrhage, control immediately. Observe head for serious bleeding. Rule out injury that compromises airway. Examine neck. If jugular flat, suspect hypovolemia. Danger of air aspiration directly into open jugular vein. Serious hemorrhage from neck: sterile occlusive dressing. Spinal injury suspected: apply rigid cervical collar. Abdomen: soft tissue injury, contusions, abrasions, rigidity, guarding, tenderness. Rule out obstructive shock. Consider pleural decompression if signs suggest tension pneumothorax. Suspect pericardial tamponade with penetrating central chest trauma
- Rapid trauma assessment (cont): Electrocardiogram (ECG) monitor; analyze cardiac rhythm. Examine pelvic and groin region. Pelvic fractures can account for blood loss of more than 2,000 mL. Assess extremities: femur, tibia/fibula, humerus fractures. Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here : 📱 Hybridgrades101@gmail.com Check distal pulse strength, capillary refill, muscle tone, sensation. Minor skin reddening may be only sign of developing contusion or serious internal injury. Classic shock signs take time to develop. Sweep body regions hidden from view. Be alert to problems other than hemorrhagic shock. Rule out cardiogenic or neurogenic shock. Assess vital signs, Glasgow Coma Scale (GCS), patient medical history, inventory injuries, determine priority for transport.
- Focused trauma assessment: Patients without signs or symptoms of serious injury or blood loss. Focus exam on area injured. Obtain baseline vital signs, Patient history, Prepare and transport.
- Additional assessment considerations: Search for internal hemorrhage evi- dence. May be flank blood or material suggestive of blood loss. Examine all body orifices for signs of hemorrhage. Increasing pulse rate, weakening pulse strength, cool and clammy skin. Orthostatic hypotension: dizziness or syncope when patient moves from supine to sitting or standing position. Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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- Differentiate from hypovolemic shock by:: Chief complaint Chest pain Dyspnea Tachycardia Heart rate Signs of congestive heart failure Dysrhythmias
- Distributive shock results from: excessive vasodilation and the impaired distri- bution of blood flow. Septic shock is the most common form of distributive shock and is characterized by considerable mortality. In the United States, this is the leading cause of noncardiac death in intensive care units (ICUs).
- Differentiate from hypovolemic shock by:: Mechanism suggesting vasodila- tion Spinal cord injury Drug overdose Sepsis Anaphylaxis Warm, flushed skin Lack of tachycardia response (not reliable)
- Obstructive shock is a form of shock associated with: physical obstruction of the great vessels or the heart itself. Pulmonary embolism and cardiac tamponade are considered forms of obstructive shock.
- Differentiate from hypovolemic shock by signs and symptoms of:: Cardiac tamponade Tension pneumothorax Pulmonary embolism
- Resuscitation: Restore adequate tissue oxygenation by:: Ensuring adequate oxygenation Maintaining effective volume-to-container Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here : 📱 Hybridgrades101@gmail.com size ratio Rapid transport to appropriate medical facility
- For red blood cell oxygenation a person needs a:: Patent airway Support ventilation with high FiO If necessary, positive-pressure ventilation Correct airway abnormalities that interfere with adequate ventilation
- Ratio of Volume to Container Size Container must be full of fluid to carry oxygen Accomplish by:: Decreasing size of container Especially in shock states not associated with hemorrhage Vasoactive medications in some distributive shock Volume replacement may be needed
- Crystalloids Solutions with dissolved: crystals in water
- Less: osmotic pressure than colloids
- Can equilibrate more quickly between: vascular and extravascular spaces
- 2/3 of crystalloid fluid leaves 3 mL of crystalloid replaces: vascular space < 1 hr 1 mL of blood
- Key Principles in Managing Shock: Open airway High-concentration oxygen if pulse ox <90% Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here : 📱 Hybridgrades101@gmail.com -Drug therapy (if needed) -Cardiogenic shock due to myocardial ischemia or infarction requires: --Reperfusion strategies --Possible circulatory support Manage tension pneumothorax and cardiac tamponade
- Neurogenic Shock: Treatment similar to hypovolemia Avoid circulatory overload Monitor lung sounds for pulmonary congestion Vasopressors may be indicated
- Anaphylactic Shock: Adrenaline is the treatment in acute anaphylactic reac- tions Other therapy Oral, IV, or IM antihistamines Bronchodilators Steroids reduce inflammatory response Crystalloid volume replacement Airway management
- Septic Shock: Management of hypovolemia (if present) Correction of metabolic acid-base imbalance Prehospital care -Fluid resuscitation -Respiratory support -Vasopressors to improve cardiac output Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here : 📱 Hybridgrades101@gmail.com -Thorough history to find source of sepsis
- For severe hemorrhage or shock:: Rapid recognition Initiation of treatment Prevention of additional injury Rapid transport to appropriate hospital Advance notification to receiving facility
- Describe how to recognize signs and symptoms of internal and external hemorrhage Define shock Outline factors needed for tissue oxygenation Describe how resistance vessels' diameter influences preload Describe function of blood components Outline changes in microcirculation during shock List causes of hypovolemic, cardiogenic, neurogenic, anaphylactic, septic shock Describe pathophysiology as basis for signs and symptoms through stages of shock Describe assessment findings to distinguish cause of shock state Outline prehospital management of shock Discuss how to integrate assessment and management of patients in shock: Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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